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Event Notification Report for September 18, 2018

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
9/17/2018 - 9/18/2018

** EVENT NUMBERS **


53585 53587 53588 53591 53592 53609 53610 53611

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Agreement State Event Number: 53585
Rep Org: KENTUCKY DEPT OF RADIATION CONTROL
Licensee: HARDIN MEMORIAL HOSPITAL
Region: 1
City: ELIZABETHTOWN   State: KY
County:
License #: 202-148-26
Agreement: Y
Docket:
NRC Notified By: ANGELA WILBERS
HQ OPS Officer: ANDREW WAUGH
Notification Date: 09/07/2018
Notification Time: 13:14 [ET]
Event Date: 09/07/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER LALLY (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - ADMINISTERED DOSE LOWER THAN PRESCRIBED DOSE

The following information was received from the Commonwealth of Kentucky via fax:

"At approximately 1045 [EDT] on September 7, 2018 an Authorized User at Hardin Memorial Hospital (HMH) called the RHB [Radiation Health Branch] supervisor to report a medical event. A HMH medical physicist determined a patient received 70 percent of an intended brachytherapy dose; the same Authorized User is adding seeds to bring the dose up to acceptable range. RHB staff have contacted the HMH Radiation Safety Officer and are awaiting further information on the possible medical event."

Kentucky Event Report ID No.: KY180003


A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.

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Agreement State Event Number: 53587
Rep Org: UTAH DIVISION OF RADIATION CONTROL
Licensee: KLEINFELDER, INC.
Region: 4
City: WEST JORDAN   State: UT
County:
License #: UT 1800085
Agreement: Y
Docket:
NRC Notified By: PHILIP GRIFFIN
HQ OPS Officer: ANDREW WAUGH
Notification Date: 09/07/2018
Notification Time: 16:00 [ET]
Event Date: 09/07/2018
Event Time: 00:00 [MDT]
Last Update Date: 09/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JASON KOZAL (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - DAMAGED GAUGE

The following was received from the State of Utah via fax:

"On September 5, 2018, a portable gauge user from Kleinfelder, Inc. (Radioactive Materials License UT 1800085) was performing compaction measurements at a field location in West Jordan, Utah. After performing a test, the operator placed the Troxler 3440 (s/n 19966) gauge on the tailgate of the licensee's vehicle to move to another location. The gauge fell off the tailgate of the truck, struck the pavement, and cracked the gauge case. The licensee performed exposure rate measurements of the gauge and incident site, and determined that the sealed sources were intact and that no contamination was present at the site. The licensee secured the damaged gauge in the transportation package, transported the gauge to the licensee's facility, and secured the gauge in the licensee's gauge storage cabinet. The licensee is conducting an investigation into the incident, and will submit a written report to the Division of Waste Management and Radiation Control (Division) within 30 days."

Utah Event Report ID No.: UT180007

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Agreement State Event Number: 53588
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: BRASKEM AMERICA INC
Region: 4
City: FREEPORT   State: TX
County:
License #: L06443
Agreement: Y
Docket:
NRC Notified By: ARTHUR TUCKER
HQ OPS Officer: ANDREW WAUGH
Notification Date: 09/07/2018
Notification Time: 17:11 [ET]
Event Date: 09/07/2018
Event Time: 00:00 [CDT]
Last Update Date: 09/07/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JASON KOZAL (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - GAUGE STUCK SHUTTER

The following information was received from the State of Texas via email:

"On September 7, 2018, the Agency [Texas Department of State Health Services] was notified by the licensee that during plant maintenance on a vessel, the handle on a Vega model SH-F2 nuclear gauge containing a 70 millicurie (original activity) Cesium-137 source was broken and the shutter was stuck in the half closed (half open) position. The license stated because of the location of the gauge on the vessel it does not create an exposure risk to any individual. The licensee has contacted a service provider to repair the gauge. Additional information will be provided as it is received in accordance with SA-300."

Texas Incident #: 9611

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Agreement State Event Number: 53591
Rep Org: NC DIV OF RADIATION PROTECTION
Licensee: DUKE UNIVERSITY MEDICAL CENTER
Region: 1
City: DURHAM   State: NC
County:
License #: 0247-4
Agreement: Y
Docket:
NRC Notified By: TRAVIS CARTOSKI
HQ OPS Officer: ANDREW WAUGH
Notification Date: 09/08/2018
Notification Time: 17:44 [ET]
Event Date: 09/07/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/08/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER LALLY (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - ADMINISTERED DOSE LOWER THAN PRESCRIBED DOSE

The following information was received from the state of North Carolina via email:

"A patient being treated for liver tumors was prescribed to receive 47.6 mCi of Y-90 microspheres, but instead received only 11.9 mCi (about 25 percent of prescribed). The remainder was in the vial as residual.

"Because this under-dosing was not due to stasis or emergent patient conditions, and the delivered dose was less than 20 percent of that prescribed, this constitutes a reportable medical event according to the 2016 version (9) of the NRC guidance for Y-90 microspheres.

"Source: Microspheres
Radionuclide: Y-90
Manufacturer: Sirtex Medical
Model: Sir-Spheres
S/N: Aggregate

"Investigation is pending for the Medical Event."

North Carolina Tracking Number: 180039


A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient.

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Non-Agreement State Event Number: 53592
Rep Org: NUCOR STEEL CORPORATION
Licensee: NUCOR STEEL CORPORATION
Region: 3
City: CRAWFORDSVILLE   State: IN
County:
License #: 13-25975-01
Agreement: N
Docket:
NRC Notified By: SHAWN AKER
HQ OPS Officer: ANDREW WAUGH
Notification Date: 09/10/2018
Notification Time: 16:02 [ET]
Event Date: 09/10/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/10/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
JOHN HANNA (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

DAMAGED GAUGE

On September 10, 2018 at approximately 0130 EDT a gauge containing a 1 Curie Am-241 source fell and was damaged. The area surrounding the gauge was isolated and the gauge was locked in a secure cabinet. On contact readings were 420 microR/hr and readings at 1 foot were 35 microR/hr. The gauge shutter has been repaired and the gauge has been reinstalled. There were no overexposures as a result of this event.

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Power Reactor Event Number: 53609
Facility: BRUNSWICK
Region: 2     State: NC
Unit: [1] [2] []
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: THOMAS SHERRILL
HQ OPS Officer: VINCE KLCO
Notification Date: 09/15/2018
Notification Time: 15:45 [ET]
Event Date: 09/15/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/18/2018
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
MIKE ERNSTES (R2DO)
CATHERINE HANEY (R2)
HO NIEH (NRR)
WILLIAM GOTT (IRD)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N N 0 Hot Shutdown 0 Hot Shutdown
2 N N 0 Hot Shutdown 0 Hot Shutdown

Event Text

UNUSUAL EVENT DUE TO SITE CONDITIONS PREVENTING PLANT ACCESS

"A hazardous event has resulted in on site conditions sufficient to prohibit the plant staff from accessing the site via personal vehicles due to flooding of local roads by Tropical Storm Florence."

Notified DHS SWO, FEMA OPS, and DHS NICC. Notified FEMA NWC, NuclearSSA, and FEMA NRCC via email.

* * * UPDATE FROM BRUCE HARTSCOK TO VINCE KLCO ON 9/28/2018 AT 1414 EDT * * *

On 9/18/2018 at 1400 EDT, the Unusual Event at Brunswick was terminated due to the ability to transport personnel to the site.

The licensee will notify the NRC Resident Inspectors.

Notified the R2DO (Guthrie), NRR EO (Miller) and the IRD MOC (Grant).

Notified DHS SWO, FEMA OPS, and DHS NICC. Notified FEMA NWC, NuclearSSA, and FEMA NRCC via email.

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Power Reactor Event Number: 53610
Facility: VOGTLE
Region: 2     State: GA
Unit: [3] [4] []
RX Type: [3] W-AP1000,[4] W-AP1000
NRC Notified By: CURTIS CASTELL
HQ OPS Officer: OSSY FONT
Notification Date: 09/18/2018
Notification Time: 08:28 [ET]
Event Date: 09/17/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/18/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
26.719 - FITNESS FOR DUTY
Person (Organization):
MIKE ERNSTES (R2DO)
FFD GROUP (EMAIL)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
3 N N 0 Under Construction 0 Under Construction
4 N N 0 Under Construction 0 Under Construction

Event Text

CONTRACT SUPERVISOR TESTED POSITIVE ON RANDOM FITNESS FOR DUTY TEST

"At 1610 [EDT] on September 17, 2018, Southern Nuclear Operating Company (SNC) determined a contractor supervisor confirmed positive for drugs during a Fitness-for-Duty (FFD) test. The employee's unescorted access to the plant has been suspended.

"The NRC Resident Inspector has been notified."

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Power Reactor Event Number: 53611
Facility: INDIAN POINT
Region: 1     State: NY
Unit: [] [3] []
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: ERIK SILKO
HQ OPS Officer: OSSY FONT
Notification Date: 09/18/2018
Notification Time: 09:06 [ET]
Event Date: 09/18/2018
Event Time: 00:00 [EDT]
Last Update Date: 09/18/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
JONATHAN GREIVES (R1DO)
JEFFERY GRANT (IRD)
Unit SCRAM Code RX Crit Initial PWR Initial RX Mode Current PWR Current RX Mode
3 M/R Y 100 Power Operation 0 Hot Standby

Event Text

MANUAL REACTOR TRIP DUE TO A STEAM LEAK ON A HIGH PRESSURE FEEDWATER HEATER

"Due to a steam leak on the reheater line to 36C Feedwater Heater, operators initiated a manual trip of the reactor, verified the reactor trip, and closed all Main Steam Isolation Valves. The plant is currently stable in Mode 3 with the steam leak isolated.

"The Auxiliary Feedwater System actuated following the trip as expected. This is reportable under 10 CFR 50.72(b)(3)(iv)(A) and 10 CFR 50.72(b)(2)(iv)(B). The unit remains on offsite power in Hot Standby at normal operating temperature and pressure.

"Decay heat is being removed from the steam generators via the Auxiliary Feedwater System and atmospheric steam dumps.

"Unit 2 was unaffected and remains at 100 percent power."

The licensee notified the NRC Resident Inspector, the State of New York, and the local transmission company.


Page Last Reviewed/Updated Friday, May 03, 2019
Friday, May 03, 2019